of the Philippines

Republic
Department of Health
OFFICE OF THE SECRETARY
OCT 29 2019

ADMINISTRATIVE ORDER
No. 2019 - (O4Y

SUBJECT: National Policy on Disaster Risk Reduction and Management in Health

DRRM-H

I. BACKGROUND AND RATIONALE

The Department of Health (DOH) is mandated to address the health needs of the
affected populations in emergencies and disasters, conflicts, epidemics, and pandemics.
Administrative Order 2004-168, the National Policy on Health Emergencies and Disasters laid
an initial framework on health emergency management, particularly on preparedness and
response.

In 2015, the 3rd United Nations World Conference on Disaster Risk Reduction adopted
the Sendai Framework for Disaster Risk Reduction 2015-2030. It also aligns with other
international covenants (e.g. Climate Change Adaptation (CCA), the Sustainable Development
Goals (SDGs), International Health Regulations (IHR) and the Paris Agreement on Climate
Change.) that emphasize the need to focus on Disaster Risk Reduction (DRR) with four
thematic areas- prevention and mitigation, preparedness, response and recovery and
rehabilitation; and the resilience building in the health sector.

The Philippines remains to

be one of the 171 countries globally with the highest number
of exposure to disasters and risks due to its location and archipelagic nature on top of the
physiologic vulnerability of specific population and age groups. In
fact, it is third on the 2018
World Risk Report. The country has withstood several natural, biological, societal and
technological disasters; namely the Typhoon Yolanda in 2013, the Marawi Armed Conflict in
2017 and the emerging and re-emerging diseases like Ebola and the Middle East Respiratory
Syndrome CoronaVirus (Mers-CoV). The DOH has adopted the country’s strategic direction
such as the AmBisyon 2040 vision of Filipinos being among the
healthiest people in Southeast
Asia by 2022, and in Asia by 2040; and National Disaster Risk Reduction and Management
Plan (2011-2028) of a safer, adaptive and disaster resilient Filipino communities toward
sustainable development. Republic Act 11223 or the Universal Health Care (UHC) geared
toward reducing vulnerability to climate change and disaster impacts seeks to address health
access and equity. Likewise, the National Objectives for Health (2017-2022) as well as
FOURmula One Plus for Health (F1 Plus) aim to increase access and provision of quality
essential health services/ products in emergencies and disasters.

Furthermore, there is a need to institutionalize DRRM-H to enhance the capacities of

the health system to manage health risks and attain resilience, thus this policy is vital and
necessary.

Il. OBJECTIVES

A. General Objective

This Order shall provide guidance

and efficient implementation of DRRM-H Program
to
all key stakeholders and agencies for the effective

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Building 1, San Lazaro Compound, Rizal Avenue, Sta. Cruz, 1003 Manila e Trunk Line 651-7800 local 1113, 1108, 1135
.

Direct Line: 711-9502; 711-9503 Fax: 743-1829 @ URL: http:/Avww.doh.gov.ph; e-mail: fiduque@doh.gov.
 B. Specific Objectives:

1. Provide policy framework on the institutionalization of DRRM-H

governance across all of
phases emergency and disaster.
at all levels of

2. Identify relevant core processes to support national and international goals as well
as targets on DRRM-H.
3. Delineate the roles and responsibilities of key stakeholders in DRRM-H.

Ill. SCOPE OF APPLICATION

This Order shall apply to the DOH Central Office (DOH-CO), DOH-Centers for Health
Development (DOH-CHDs), DOH Hospitals, Sanitaria, Treatment and Rehabilitation Centers
(TRCs), Blood Service Facilities, and its attached agencies; all
public and private healthcare
facilities, National Government Agencies (NGAs); Ministry of Health - Bangsamoro
Autonomous Region in Muslim Mindanao (MOH-BARRM); Local Government Units
(LGUs) including primary care facilities and LGU hospitals; local and international non-
government organizations (NGOs); humanitarian/development partners; civil society
organizations (CSOs); academic institutions; and all other relevant institutions for the
implementation of the DRRM-H.

IV. DEFINITION OF TERMS

A. All-hazards approach - involves taking the actions necessary to prepare for,

respond to, and recover from hazards ofall
types.

B. Disaster Risk Reduction and Management

systems-based, multi-sectoral process that
in
utilizes -
Health (DRRM-H) an integrated,
policies, plans, programs,
strategies to reduce health risks due to disasters and emergencies, improve
preparedness for adverse effects and lessen adverse impacts of hazards to address
needs of affected population with emphasis on the vulnerable groups.

C. DRRM-H Institutionalization - establishment of a functional DRRM-H system in

all levels of governance, which includes the following minimum key indicators:
DRRM-H plan with necessary budget allocation; health emergency response teams;
essential health emergency commodities; and functional emergency operations
center for command, control, communication, and coordination.

D. DRRM-H Plan
- a long term development plan containing DRRM-H measures in
the four thematic areas.

E. DRRM-H mainstreaming - the process of integrating DRRM-H concerns in

relevant health and non-health policies, programs, projects and activities.
all
F. Essential Health Service Packages - stipulated in AO 2017-0007 to provide a
focused approach for all affected individuals especially the vulnerable and
marginalized populations during emergencies and disasters.

G.
-
Emergency Operations Center (EOC) is a physical location in which designated
emergency management functions are performed; supports the Incident
Management Command Team as to
gathering and analyzing data, coordinating and
communicating.
 -
H. Operations Center refers to facility that is structurally and strategically located in
a pre-identified area during normal condition, conducts monitoring and produces
routine reports.

I. Health Emergency Commodities - refers to essential medicines, medical supplies,

kits, reagents and other laboratory supplies, drinking water containers, equipment,
collaterals, and other similar items for use in emergencies and disasters.
J. Health Emergency Response Team (HERTS) - all types of teams defined in
Administrative Order No. 2018-0018 that are mobilized during events, emergencies,
and disasters to provide health and health-related services by any health sector
agency/organization, whether local or international.

K. Health resilience - the capacity of a health system to absorb, adapt and transform
when exposed to shock such as pandemics, natural and human-induced disasters
such as armed conflict and still retain the same control onits
structure and functions.

L. Prevention and mitigation in DRRM-H - avoiding hazards and limiting their

potential health impacts by reducing exposure to the hazards and the existing
vulnerabilities of the community, through strengthening day-to-day operations of
different health programs, assessing and reducing risks in structural resilience or
integrity of health infrastructure facilities through regular engineering and
maintenance checks.

-
M. Preparedness in DRRM-H strengthening capacities of communities to anticipate,
cope, and ensure early recovery from the negative health impacts of emergencies and
disasters.

N. Response in DRRM-H
-preserving lives, reducing health impacts, and meeting the
basic health needs of the affected population during or immediately after an
emergency or disaster.

O. Recovery and rehabilitation in DRRM-H - restoring and improving health

facilities, health conditions, and organizational capacity of affected communities,
and reduce disaster risks.

V. GUIDING PRINCIPLES

A. People-Centered. DRRM-H implementation shall adopt gender-sensitive and

culturally appropriate interventions that address the needsof
the affected population,
especially the vulnerable and disadvantaged groups.

B. All-hazards approach in policy, planning and program implementation.

DRRM-H implementation shall strengthen the development of core capacities such
as policy, planning and program implementation across all
hazards.

C. Whole of society approach that is holistic and proactive. DRRM-H

implementation shall advance and engage multi-sectoral and multidisciplinary
initiatives and interventions across the thematic areas.
 D. Community empowerment and resilience. DRRM-H institutionalization shall
encourage grassroots community participation and forge crucial partnerships among
local government units, non-government, and civil society organizations.

E. Science and evidence based. DRRM-H shall support decision-making and

policymaking through the utilization of evidences from climate and disaster-related
data and linkage to multi-hazard early warning systems.

F, Equity in the delivery of essential health services. DRRM-H shall promote the
improvement of the health status of vulnerable groups particularly low service
coverage in high-risk areas.

VI. GENERAL GUIDELINES

The DRRM-H framework embodies the significant input of increase in investments in

DRRM-H; defines enabling processes (governance, health service delivery, resource
mobilization and management, information and knowledge management) resulting to specific
outputs (DRRM-H plan, health emergency response teams, health emergency commodities and
emergency operations center) to achieve health outcomes toward a resilient health system in
all levels of governance. (Refer to Annex A)

A. DRRM-H shall be institutionalized atall levels of governance and in

all health service
delivery units, maintaining resilience of the health system in all phases of the
or disaster.
emergency

B. DRRM-H shall be mainstreamed into all health and non-health policies, plans, and
programs in order to capacitate and build resilient systems, especially in the
communities.

C. All health service delivery units shall have initiatives on the DRRM-H framework
core processes: (a) Governance, (b) Health Service Delivery, (c) Resource
Mobilization and Management, and (d) Information and Knowledge Management.

D. All stakeholders shall make available and accessible essential health services to the
affected population during times of emergencies and disasters.

E. All levels of governance and stakeholders shall support increase investments on

DRRM-H to include but not limited to human resources for health, logistics,
infrastructure and equipment, information management system.

V. SPECIFIC GUIDELINES

A. DRRM.-H institutionalization shall comprise of at least: (a) an approved, updated,

tested and disseminated DRRM-H Plan; (b) organized and trained Health Emergency
Response Teams (HERTs); (c) available and accessible health emergency
commodities, and (d) functional Operations Center/ Emergency Operations Center
(OC/EOC).

Py
B. The resilience of the
community and the health system shall be sustained through the
following mechanisms:

1. Promotion of resilience in new and existing health care facilities thru engineering
and maintenance of health infrastructure to also include critical infrastructure like
water, energy, transport, and telecommunications.
2. Intensification of health promotion and communication particularly in areas that
are high risk for certain natural calamities such as flood-prone areas, earthquake-
prone areas and those in the fault line, landslide areas, near seas and oceans
community, geographically isolated and depressed areas (GIDAs), to
also include
Indigenous People (IPs) areas.
3. Conduct of annual emergency drills in institutions such as schools, offices,
hospitals and health facilities.
4. Development of a community network of health emergency responders.

C. In the implementation of DRRM-H, the following core processes shall be

strengthened through the following measures:

1. Governance
a. Setting up a mechanism of command and control, coordination, and
communication and partnership with all stakeholders;
b. Creation of standards, recognition of best practices, promotion and advocacy
on DRRM-H;
Development of monitoring and evaluation that shall identify core outcome,
output, process, and input indicators—and mechanism for generating,
processing, analyzing, reporting, disseminating and using these indicators for
policy and program development related to DRRM-H.

2. Health Service Delivery

a. Strengthening of Health Care Provider Network and referral system in
emergencies and disasters;
b. Establishment and maintenance of emergency operations center with an early
warning system, communication mechanisms, technology, and equipment;
Updating and upgrading technical and logistical capacities of disaster health
workers, community leaders, and volunteers;
Promotion of disaster preparedness, response, and recovery capacities based
on implementation of the DRRM-H promotion plan.

3. Resource Mobilization and Management

a. Provision of essential health service package pursuant to AO 2017- 0007:
Guidelines in the Provision of the Essential Health Service Package in
Emergencies and Disasters and its amendment;
Organization and mobilization of health emergency response teams that are
equipped with adequate and appropriate tools, supplies and equipment;
Mobilization of need-based financial and logistics resources;
Investment on new and existing health care facilities that are safe and
disaster-ready.

4. Information and Knowledge Management

a. Systematic collection and use of baseline information on risks, vulnerability,
capacity and exposures, and hazard characteristics;
 b. Upgrade reporting system to include conventional and alternative approaches
such as real-time reporting for timely, updated, easily accessible and reliable
data on health and emergencies;
c. Documentation and post-incident evaluation activities and case reports;
d. Conduct of research on DRRM-H
tosupport policy and practice.

D. Essential health service packages shall utilize the cluster approach that includes: (a)
Public Health and Medical, (b) Nutrition; (c) Water, Sanitation and Hygiene (WASH);
and (d) Mental Health and Psychosocial Support (MHPSS), as stipulated in A.O.
2017-0007 and its amendments.

VI. MONITORING AND EVALUATION

A. Specific policy statements shall have an equivalent Standard Operating Procedures

(SOPs) with a corresponding biennial report analysis of its adaptation and
implementation. Otherwise, this policy and its succeeding SOPs may be revised
accordingly based on new evidence, local and international development on health
emergencies and disasters.

B. Ensure the institutional, operational monitoring and evaluation

levels of governance.
of DRRM-H
in all

VIE. ROLES AND RESPONSIBILITIES

The DOH Central Office shall act as the lead agency, along with the LGUs, for the
implementation of this Order. The following shall summarize the roles and functions of the
different groups of stakeholders that have critical roles in DRRM-H.

A. Department of Health Central Office

1. Public Health Services Team (PHST)
a. Health Emergency Management Bureau (HEMB)
1) Establish a mechanism of command and control, coordination, and
communication in DRRM-H with all stakeholders.
2) Develop standards and guidelines to implement DRRM-H and provide
technical assistance in the institutionalization at all levels of governance
and in the mainstreaming in all health policies, programs, and activities.
3) Establish and maintain a 24/7 Operations Center and Emergency Operation
Center at the national level.
4) Coordinate with other National Government Agencies and other
stakeholders in the implementation and institutionalization of the DRRM-
H
5) Lead in the monitoring of DRRM-H through the Centers for Health
Development.

b. Disease Prevention and Control Bureau (DPCB)

1) Support the development of DRRM-H related policies and mainstream
DRRM-H strategies in relevant programs andactivities.
2) Support the augmentation of budget, logistics, and provision of necessary
technical assistance for the implementation and delivery of EHSP during
emergencies and disasters.
 c. Health Promotion and Communication Service (HPCS)
1) Provide technical support in the development of risk communication for
informed decisions in times of disasters.
2) Provide technical support in the development of
information, education and
communication (IEC) strategies in support of DRRM-H.

d. Epidemiology Bureau (EB)

1) Lead in the conduct of surveillance, and outbreak investigation during
emergencies and disasters.

e. National Nutrition Council (NNC)

1) Ensure the timely and appropriate delivery of quality package of nutrition
interventions as specified on AO 2017-0007 and its amendments

2. Health Policy and Systems Development Team (HPSDT)

a. Bureau of Local Health Systems Development (BLHSD)
1) Include the institutionalization of DRRM-H system as a key feature in the
policy and health systems development and evaluation of the Health Care
Provider Network (HCPN).
2) Assist the LGUs, through the DOH Centers for Health Development
(CHDs), in the development oflocal investment plan for health to support
DRRM-H.

3. Field Implementation and Coordination Team (FICT) shall assist HEMB to

oversee and coordinate with its
field unit’s matters concerning the implementation
of DRRM-H.
a. Centers for Health Development (CHDs), DOH Hospitals and other
Healthcare Facilities
1) Lead in the institutionalization of DRRM-H at the regional level and
mobilize different fund sources.
2) Create a dedicated and functional unit with clear roles, responsibilities,
and lines of accountability to ensure rapid decision-making during
emergencies and disasters.
3) Implement an approved, updated, tested, disseminated and funded
DRRM-H plans.
4) Organize and develop a system to capacitate CHD/hospital HERTs.
5) Adopt and develop a system for logistics management to ensure the
availability and accessibility of health emergency commodities.
6) Adopt/develop a system of mobilization of HERTs that are compliant to
AO 2018-0018
7) Identify, organize and mobilize HERTs in coordination with partners and
LGUs
8) Establish/ maintain a functional Operations Center.
9) Support and participate in the development of relevant, long-term,
solution-driven research in DRRM-H.
10) For hospitals, comply with Hospital Safe from Disaster Policy, standards,
and guidelines.

B. Local Government Units (LGUs)

1. Ensure that health facilities/office/units adopt policy standards on Hospitals Safe
from Disasters (2013-0014) and integrate the same to DRRM-H Planning.
C
 2. Develop a local DRRM-H plan that is responsive to the needs of the LGU,
compliant to the LGU scorecard, and integrated with relevant LGU plans.
3. Provide DRRM-H learning and development to health service providers.
4, Identify, organize and mobilize HERTs that are consistent with the provisions of
AO 2018-0018.
5. Collaborate with CSOs, local and international NGOs, indigenous people groups,
vulnerable and disadvantaged communities to improve resilience at the barangay
level.
6. Allocate budget for DRRM-H from LGU’s internal revenue allotment or other
relevant fund allocation/donations.
7. Establish/ maintain a functional EOC.

C. Ministry of Health ~ Bangsamoro Autonomous Region in Muslim Mindanao

(MOH — BARRM) shall perform the roles and responsibilities stated under the section
on Centers for Health Development, DOH Hospitals and other Healthcare facilities.

D. National Government Agencies, Non-Government Organizations, Civil Society

Organizations, local and international Non-Government Organizations /
international Humanitarian Partners/ Development Partners, Academe and
Private Sector
1. Support in the provision of technical assistance to all key stakeholders in the
implementation of DRRM-H strategies.
2. Participate in relevant, long-term, solution-driven learning and development
interventions and researches in DRRM-H.

VIII. REPEALING AND SEPARABILITY CLAUSES

The provisions from Administrative Order 168 s. 2004 and other related issuances that
are inconsistent or in contrary to this Order are hereby amended and modified accordingly.
Furthermore, all provisions of existing related issuances which are
not affected by this Order
shall remain valid andin effect.

IX. EFFECTIVITY

This order shall take effect immediately after its publication in a newspaper of general
circulation.

Secretary of Health
FinalOutcomes

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=

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Intermediate
Outcomes DRRM-H Institutionalization and strengthening institutional capa

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on Response Teams Commodities #
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Processes

inputs
Increased Investments in Disaster Risk Reduction and Management in Health

Figure 1: DRRM-H Framework

This Disaster Risk Reduction and Management in Health (DRRM-H) framework levels atall
of governance — in the DOH Central Office, Centers for Health Development, DOH Hospitals,
and other healthcare facilities, Local Government Units - illustrates that if there are increased
investments in DRRM-H inputted in the health system, whether be in health human resource,
commodities, equipment, etc., there will be enhancement in the processes in governance,
it
service delivery, resource mobilization and management and information and knowledge
management. Minimum inputs/indicators to institutionalize DRRM-H are the plan, health
emergency response teams, health emergency commodities and functional Emergency
Operations Center. This will lead to the attainment of the three-fold goal: uninterrupted health
service delivery during emergencies and disasters, preventable morbidities and mortalities as
well as other secondary health effects averted to have a safer adaptive and disaster-resilient
Filipino communities toward sustainable development. This should also be highlighted in the
role of other agencies in DRRM-H.
ANNEX B: Roles and Responsibilities of other offices in the DOH — Central and attached
agencies

A. Health Policy and Systems Development Team (HPSDT)

1. Health Policy Development and Planning Bureau (HPDPB)

a. Ensure the inclusion of DRRM-H in the integrated health agenda of policy,
research, planning, and legislative development.

2. Bureau of International Health Cooperation (BIHC)

a. Ensure timely processing of requests and acceptance of foreign donations during
disasters, including but not limited to food and non-food items, drugs and
medicines, medical devices and equipment and other related products in accordance
with the existing guidelines on foreign donations.
b. Provide guidelines and assist in the processing of documents for the deployment
international HERT/ volunteers.
of
3. Health Human Resources Development Bureau (HHRDB)
a. Serve as a clearinghouse in the development of an integrated DRRM-H capacity
development module and training plan.
b. In coordination with the DOH CHDs, establish partnerships with tertiary hospitals
and academic institutions as training hubs for DRRM-H, and augment in the
deployment of HRH with DRRM-H competencies at the community level.

4. Philippine Health Insurance Corporation (PHIC)

a. Guarantee continuing healthcare benefits (e.g. case-rate payments) and no balance
billing in times of emergencies or disaster.

B. Public Health Services Team (PHST)

5. National Voluntary Blood Services Program (NVBSP)

a. Ensure availability of blood and blood products especially during emergency or
disaster.

C. Health Facilities and Infrastructure Development Team (HFIDT)

6. Health Facilities Development Bureau (HFDB)

a. Develop standards on Hospitals Safe from Disasters.
b. Develop guidelines for the continuous operation of health facilities following an
emergency and for the construction or rehabilitation of disaster-resilient health
facilities.

7. Knowledge Management and Information Technology Service (KMITS)

a. In collaboration with HEMB, establish, maintain and utilize an emergency
information system between and among the health sector and other relevant
partners.

8. Health Facility Enhancement Program (HFEP)

a. Monitor the structural and non-structural aspects of health care facilities particularly
during emergency and disaster.

10
D. Health Regulation Team

9. Food and Drug Administration (FDA)

a. Together with BIHC, develop guidelines and procedures on the entry of foreign-
donated emergency drugs, medicines, medical supplies and/or other
commodities.
b. Provide technical inputs in the health sector’s plan for nuclear and radiological
incidents including the development of guidelines, definition, identification,
and management of cases.

10. Health Facilities Services and Regulatory Bureau (HFSRB)

a. Enforce the compliance of hospitals and other health facilities to Hospital Safe
from Disaster requirements.

11. Bureau of Quarantine (BOQ)

a. Strengthen surveillance and infection control measures to prevent entry and
exit of infectious diseases during emergencies and disasters.

12. Pharmaceutical Division (PD)

a. Reallocate stocks and support in the enforcement of
price control of essential
medicines in affected areas during emergencies and disasters.

E. Procurement and Supply Chain Management Team

13. Supply Chain Management Office (SCMO)

a. Establish an efficient logistics management system to improve response
operations, but not limited to warehousing, brokerage and hauling of goods and
commodities.

14. Procurement Service (PS)

a. Expedite procurement and delivery systems during disasters.

¥. Administrative and Financial Management Team

15. Financial Management Service (FMS)

a. Facilitate and assist in monitoring the appropriate utilization of the national
and regional DRRM-H Fund.

16. Administrative Service (AS)

a. Provide and facilitate readiness and availability of motor pool atall times during
disasters and emergencies and other administrative concerns needed